WASHINGTON - January 20 - The U.S. Supreme Court affirmed the freedom of states to control their own public health policies on January 17 in a 6-3 ruling (PDF) that upheld Oregon's Death With Dignity Act.

Oregon's law, passed in 1997, makes physician-assisted suicide legal for terminally ill patients. Former U.S. Attorney General John Ashcroft started fighting in 2001 to overturn the voter-approved law on the grounds that prescribing drugs to hasten death violates the Controlled Substances Act, the statute that governs federal drug policies.

The CSA specifies that controlled substances can be prescribed only for a "legitimate medical purpose," and Ashcroft contended that the CSA gave him the authority to determine what constituted a legitimate medical purpose in Oregon.

Two lower courts decided against the Attorney General, but the case proceeded under Attorney General Gonzales all the way to the U.S. Supreme Court. The American Public Health Association, working with the Alliance and Alliance-affiliated lawyers, submitted amicus (friend-of-the-court) briefs in the Supreme Court case urging the Court to reject the government's all-encompassing view of the CSA.

The Supreme Court agreed that the Attorney General’s interpretation of the Controlled Substances Act was not reasonable. The Court concurred with the APHA's argument that the Attorney General’s authority under the Controlled Substances Act must be measured and limited by the core purpose of that statute – i.e., prevention of the illicit drug trade.

The Attorney General's authority to enforce laws aimed at the illegal distribution of controlled substances could not be expanded to allow him to judge what constitutes a legitimate medical practice based on his moral and ethical objections.

The interpretation of the law the Government advanced, the APHA explained, would entitle the Attorney General to impose on the entire nation his personal views on matters of intense medical and moral disagreement, any time the issue happened to involve the prescription of federally controlled drugs. This would include, for example, physician-assisted suicide, abortion, capital punishment, infertility and cancer treatments, and stem cell research.

In its ruling, the Supreme Court took pains to highlight and reaffirm the historic role of the states in regulating the practice of medicine and safeguarding the public health, and their power to pursue these responsibilities through measures and policies that are novel, controversial or strongly disapproved-of in other parts of the nation. Even more significantly, the Court read the Controlled Substances Act as respecting this important role for the States.

By restoring the balance between federal and state roles in the health policy arena – and denying the Attorney General a broad and unrestrained veto over policy experimentation at the State level – the Oregon decision should help to dispel the long shadow that federal drug law enforcement has recently cast over innovative and highly promising public health policy initiatives.

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